CPT 61616 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Surgery • Surgical Procedures on the Nervous System |
| Common Place of Service | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital • 23 - Emergency Room |
| Common Modifiers | • None • 62 - Co-Surgeons • 22 - Increased Procedural Services |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 61616 |
National average reimbursement for CPT 61616 by major payers:
$4,239.39
$4,518.87
$4,837.37
$5,488.54
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 61616 | ||||||
United | 61616 | $2732.00 | 1104373315 - BRENTWOOD SURGERY CENTER, LLC, BRENTWOOD SURGERY CENTER | 200533890 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61616 | $2355.00 | 1154460525 - VIRGINIA MASON MEDICAL CENTER, VIRGINIA MASON LYNNWOOD ASC | 910565539 - (WA) VIRGINIA MASON MEDICAL CENTER | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61616 | $1274.00 | 1043803877 - PALM BEACH INTERNATIONAL SURGERY CENTER LLC, PALM BEACH INTERNATIONAL SURGERY CENTER AT THE PALEY INSTITUTE | 384092545 - (FL) PALM BEACH INTERNATIONAL SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61616 | $459.00 | 1396022257 - RIDGECREST SPECIALTY SURGERY CENTER A PROFESSIONAL CORPORATION | 453602999 - (CA) RIDGECREST SPECIALTY SURGERY CENTER A PROFESSIONAL CORPORATION | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61616 | $273.00 | 1669668943 - POOLE ENDOSCOPY CENTER, NEEL KAMAL MD | 521831316 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61616 | $2013.00 | 1700341468 - PORT WARWICK SURGERY CENTER, LLC | 832749039 - (VA) PORT WARWICK SURGERY CENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61616 | $400.00 | 1750414983 - ROCKLEDGE SURGERY CENTER, INC. | 522098503 - (MD) ROCKLEDGE SURGERY CENTER INC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61616 | $1955.00 | 1154844553 - LONE STAR ENDOSCOPY CENTER, LLC, LONE STAR ENDOSCOPY SOUTHLAKE | 273635726 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61616 | $699.00 | 1225377278 - CENTER FOR MINIMALLY INVASIVE SURGERY PLLC, SOUNDVIEW AMBULATORY SURGERY CENTER | 911661866 - (WA) CENTER FOR MINIMALLY INVASIVE SURGERY, PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61616 | $650.00 | 1457010209 - HNC, LLC, KAIZEN SURGERY CENTER | 364971722 - (CA) HNC LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61616 | $150.00 | 1790237501 - AMERICAN ACCESS CARE OF SP ASC LLC | 814086575 - (PA) AMERICAN ACCESS CARE OF SP ASC LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61616 | $340.00 | 1598952061 - ENDOSCOPY ASSOCIATES, LLC | 142006705 - (VA) ENDOSCOPY ASSOCIATES LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61616 | $527.00 | 1528622321 - PREMIER-COVENANT ASTC LLC, PREMIER AMBULATORY SURGERY CENTER | 834550993 - (TN) PREMIERCOVENANT ASTC LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61616 | $1064.00 | 1790104248 - METRO SURGERY CENTER, LLC, METRO SURGERY CENTER, LP | 810587498 - (AZ) METRO SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61616 | $1418.00 | 1588938682 - WEST SIDE GI, LLC | 271185812 - (NY) WESTSIDE GI CENTER, LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 61616 vs. Other Surgical Procedures on the Nervous System Codes
The CPT 61616 code is part of the Surgery services used for Surgical Procedures on the Nervous System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 61616 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 61600-CPT | High | Resect/Excisn Neopl, Vasc Or Infect Lesn Ant Cranial Fossa; Extradural |
| 61601-CPT | High | Resection Or Excision Of Neoplastic, Vascular Or Infectious Lesion Of Base Of Anterior Cranial Fossa; Intradural, Including Dural Repair, With Or Without Graft |
| 61605-CPT | High | Resection Or Excision Of Neoplastic, Vascular Or Infectious Lesion Of Infratemporal Fossa, Parapharyngeal Space, Petrous Apex; Extradural |
| 61616-CPT | High | Resection Or Excision Of Neoplastic, Vascular Or Infectious Lesion Of Base Of Posterior Cranial Fossa, Jugular Foramen, Foramen Magnum, Or C1-C3 Vertebral Bodies; Intradural, Including Dural Repair, With Or Without Graft |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 61616. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 61616 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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